Fred J Petrilla Jr., PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PY0002507 Issued in FL

Practice address

1903 25TH St
Vero Beach, FL 32960-3366

Phone

(772) 562-0777

Fax

(772) 770-3285

NPI assigned

Dec 27, 2005

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jan 1, 2017 through Jan 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1135641600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1323302400000",
    "number": "1881671386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1903 25TH ST",
            "address_2": "PO BOX 789",
            "city": "VERO BEACH",
            "state": "FL",
            "postal_code": "329603366",
            "telephone_number": "772-562-0777",
            "fax_number": "772-770-3285"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1903 25TH ST",
            "city": "VERO BEACH",
            "state": "FL",
            "postal_code": "329603366",
            "telephone_number": "772-562-0777",
            "fax_number": "772-770-3285"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRILLA",
        "first_name": "FRED",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-12-27",
        "last_updated": "2011-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY0002507",
            "primary": true
        },
        {
            "code": "103TS0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, School",
            "state": "FL",
            "license": "SS33",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peter G Wernicki M D P a
• Arley A. Peter, M.D.
• John Peter Petersen, M.D.
• Julia Peterson, M.S., CFY-SLP
• Leuna Petitval
• Linda Kay Petrilla, PH.D,
• Claire Petrulak
• Margaret A Pfalzgraf, ARNP
• Miranda Pfautsch, DO
• Kelly Pfeiffer

• Clinical Psychologist in Vero Beach, FL
• Providers in Vero Beach, FL by specialty
• Clinical Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.